title: Comparison of three intervention models for promoting circumcision among migrant workers in western China to reduce local sexual transmission of HIV.
abstract: OBJECTIVE
  Three models for promoting male circumcision (MC) as a preventative intervention against HIV infection were compared among migrant worker populations in western China.
  
  
  METHODS
  A cohort study was performed after an initial cross-sectional survey among migrant workers in three provincial level districts with high HIV prevalence in western China. A total of 1,670 HIV seronegative male migrants were cluster-randomized into three intervention models, in which the dissemination of promotional materials and expert- and volunteer-led discussions are conducted in one, two, and three stage interventions. Changes in knowledge of MC, acceptability of MC, MC surgery uptake, and the costs of implementation were analyzed at 6-month and 9-month follow-up visits.
  
  
  RESULTS
  All three models significantly increased the participants' knowledge about MC. The three-stage model significantly increased the acceptability of MC among participants and led to greatest increase in MC uptake. At the end of follow-up, 9.2% (153/1,670) of participants underwent MC surgery; uptake among the one-, two-, and three-stage models were 4.9%, 9.3%, and 14.6%, respectively. Multivariable Cox regression analysis showed that three-stage model was the most effective method to scale up MC, with RR = 2.0 (95% CI, 1.3-3.1, P=0.002) compared to the on-site session model. The two-stage intervention model showed no significant difference with either the on-site session model (RR=1.5, 95% CI, 0.92-2.4, P=0.12) or three-stage model (P=0.10).
  
  
  CONCLUSIONS
  A three-stage intervention with gradual introduction of knowledge led to the significantly increase in MC uptake among migrant workers in western China, and was also the most cost-effective method among the three models.
authors.affiliation: School of Public Health, Guangxi Medical University, Nanning, Guangxi, China ; Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China.
authors.forename: Chuanyi
authors.initials: C
authors.lastname: Ning
authors.forename: Junjun
authors.initials: J
authors.lastname: Jiang
authors.forename: Li
authors.initials: L
authors.lastname: Ye
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Yang
authors.forename: Bo
authors.initials: B
authors.lastname: Wei
authors.forename: Wei
authors.initials: W
authors.lastname: Deng
authors.forename: Suosu
authors.initials: S
authors.lastname: Wei
authors.forename: Jiegang
authors.initials: J
authors.lastname: Huang
authors.forename: Bo
authors.initials: B
authors.lastname: Qin
authors.forename: Halmurat
authors.initials: H
authors.lastname: Upur
authors.forename: Chaohui
authors.initials: C
authors.lastname: Zhong
authors.forename: Qianqiu
authors.initials: Q
authors.lastname: Wang
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.forename: Fumei
authors.initials: F
authors.lastname: Wei
authors.forename: Na
authors.initials: N
authors.lastname: Xu
authors.forename: Peiyan
authors.initials: P
authors.lastname: Xie
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Hsi
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.forename: Hao
authors.initials: H
authors.lastname: Liang
mesh_terms: D002681:China; D002944:Circumcision, Male / Q000191:economics / Q000193:education*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D014171:Transients and Migrants